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Lower blood concentrations of protein-bound solutes have been directly linked to better outcomes in patients on dialysis. Studies indicate that clearance of protein-bound solutes is more efficient in patients on hemodialysis than in those on peritoneal dialysis; however, paradoxically, the circulating levels of these solutes are lower in patients on peritoneal dialysis. Vanholder and colleagues consider possible explanations for this discrepancy, such as differences in intestinal generation or metabolism of these molecules.

Home haemodialysis offers increased flexibility over in-centre haemodialysis for adopting different dialysis regimes aimed at improving solute removal. In this Review, Vanholder et al. discuss strategies that can improve haemodialysis adequacy in the home setting. The authors examine vascular access, reaching dialysis adequacy targets, increasing dialyser pore size, increasing dialysis frequency, and increasing dialysis duration, and also discuss the idea of the wearable artificial kidney.

A recent study has reviewed records of patients on thrice-weekly hemodialysis and shown that serious and fatal complications—including overall and cardiac mortality, as well as hospitalization for cardiovascular reasons—are more frequent on the last day of the long interdialytic interval than on other days.

A recent study developed a formula predicting hard outcomes of rhabdomyolysis (dialysis and death). Based on a rigid analytical approach, an eight factor score was elaborated with acceptable prognostic value, but clinical usefulness at this time seems limited. Perhaps the most promising application is for triage.

'Middle molecules' (those in the molecular weight range of 500–60,000 Da, such as β₂-microglobulin), are not easily removed by dialysis and are believed to mediate some of the effects of the uremic syndrome. The authors of this Viewpoint argue that Kt/V_ureais flawed as a sole indicator of dialysis adequacy, and that we need new indices to quantify removal of these middle molecules in patients on dialysis.

Graft stenosis, which can lead to thrombosis, is a major problem in hemodialysis patients with arteriovenous grafts. Does anti-aggregation with dipyridamole and aspirin help to prolong the primary patency of vascular access grafts?

Here, the ASN-ERA-EDTA-ISN Joint Working Group on Ethical Issues in Nephrology highlights ten areas of ethical concern as priority challenges that require collaborative action and discusses the need for development of ethical training and guidance tools to manage these issues.

The deterioration of the peritoneal membrane during peritoneal dialysis is a serious problem as it leads to technique failure. The factors that have attracted the most attention as culprits in peritoneal membrane deterioration are those related to the peritoneal dialysis fluid itself, such as pH, glucose, and glucose degradation products. This Review focuses on the other factors-many of them modifiable-that can affect peritoneal membrane quality and could be targeted to preserve the peritoneal membrane.

The devastating effects of war are far-reaching and particularly affect people with kidney disease. The Ukrainian conflict has highlighted problems encountered in the provision of support for this vulnerable group. On the basis of these and previous experiences in massive disasters, we propose a sustainable action plan to prepare for similar logistical challenges in future conflicts.

The treatment of chronic kidney disease (CKD) and end-stage renal disease (ESRD) is associated with immense societal costs, with particularly high expenditure for renal replacement therapy. This Review addresses the economic aspects of CKD and ESRD with a focus on approaches to prevent the conditions that contribute to CKD and its progression.

Currently available biomarkers for the detection and prognosis of kidney disease offer an imperfect indication of kidney function, and are not useful across all types of kidney disease. In this Review, the authors describe the current status of proteomic and protein biomarkers for kidney diseases and discuss current barriers to the discovery, validation and clinical implementation of novel proteomic biomarkers.

Urinary components can reflect kidney biology in health and disease. Here, the authors examine current data on urinary biomarkers that can provide insight into kidney function and metabolism, and discuss their potential application value as diagnostic, prognostic and/or therapeutic monitoring biomarkers.

This Review provides a guide to metabolite retention in kidney disease and includes an overview of key uraemic toxins and the complex mechanisms underlying their toxicity, as well as a discussion of key strategies with the potential to prevent or mitigate their adverse effects.

Kidney disease risk and outcomes are strongly associated with inequities that occur across the entire clinical course of the disease. The authors of this Review describe the different inequities that affect kidney health and care worldwide, and consider potential solutions to help to mitigate these.

Organ transplantation improves patient survival and quality of life and has a major beneficial impact on public health and the socio-economic burden of organ failure. This Roadmap presents an outline of the challenges to increasing transplantation rates and proposes 12 key areas along with specific measures that should be considered to promote transplantation.

The existence of several different definitions of acute renal failure makes it difficult to determine the true epidemiological characteristics of this condition. Nonetheless, there have been notable variations in its epidemiology during the past few decades. Norbert Lameire and colleagues present an overview of these changes and their causative factors, including geography, patient setting and ageing populations.

Chronic kidney disease (CKD) affects numerous organs and systems, which in turn have effects on kidney function. This Review provides an overview of CKD as a systemic disease and discusses the multidirectional links between the kidney, bone, nervous and immune systems, and metabolism.

Chronic kidney disease (CKD) is associated with several alterations in protein post-translational modifications. Here, the authors examine the evidence of these alterations, their links with CKD progression and cardiovascular risk in patients with CKD, and their potential clinical applications.

Despite notable progress in basic, clinical and translational nephrology research in the past 50 years, many challenges remain. In this Review, the authors provide an overview of the current status and future directions in nephrology research and patient care.

During disasters, the morbidity and mortality of patients with kidney disease far exceeds that of the general population. Here, the authors discuss the medical and logistical problems that are faced by these patients and their care-givers during mass disasters and suggest pragmatic approaches to improve patient outcomes.

Here, the authors review techniques for cardiovascular diagnosis, screening and monitoring in patients with CKD, including approaches to the diagnosis of cardiac ischaemia, left ventricular hypertrophy and dysfunction, arrhythmia, cerebrovascular disease, peripheral arterial disease, arterial stiffness and hypertension.

Chronic kidney disease (CKD) is associated with alterations in serum lipid profiles that contribute to kidney and cardiovascular disease. Here, the authors examine these changes in serum levels, metabolism and post-translational modifications of lipoproteins and fatty acids that characterize CKD-associated dyslipidaemia.

This Review focuses on the epidemiology, pathogenesis and treatment of dyslipidaemia in patients with chronic kidney disease (CKD) and end-stage renal disease. The authors discuss emerging clinical data on the use of novel lipid-lowering agents and reappraise the 2013 KDIGO Guidelines for Lipid Management in CKD.

Dialysis is a life-saving therapy; however, costs of dialysis are high, access is inequitable and outcomes are inadequate. This Review describes the current landscape of dialysis therapy from an epidemiological, economic, ethical and patient-centred framework, and describes initiatives that are aimed at stimulating innovations in the field to one that supports high-quality, high-value care.